ES2302298T3 - SURGICAL INSTRUMENT TO REMOVE AN INTERVERTEBRAL IMPLANT. - Google Patents

Abstract

Surgical instrument (22) for removing an intervertebral implant (12) from an intervertebral space (14) of a human or animal spine 20, comprising a coupling piece (42) arranged at the distal end of the instrument (22) to seat against the intervertebral implant (12) in a seating position, the coupling piece (42) being able to be brought from the seating position to a coupling position in which the intervertebral implant (12) is attached to the coupling piece (42) with a geometric and / or force adjustment, the coupling part (42) comprising at least a first coupling element (52) and at least a second coupling element (70) which can be reached in the coupling position to be engaged with the intervertebral implant (12), characterized in that the at least one first coupling element (52) and the at least one second coupling element (70) are arranged with the possibility of moving be relative to each other such that the separation of the at least one first coupling element (52) and the at least one second coupling element (70) can be varied in a direction parallel to a longitudinal axis (38 ) defined by the instrument (22), to pass the instrument (22) from the seating position to the coupling position and / or vice versa.

Description

Surgical instrument to remove an implant intervertebral

The present invention relates to a surgical instrument to remove an intervertebral implant from a  intervertebral space of a human or animal spine, comprising a coupling piece arranged at the end distal of the instrument to seat against the implant intervertebral in a seating position, being able to take the coupling piece from the seat position to a position of coupling in which the intervertebral implant is held in the coupling piece by geometric and / or force adjustment, the coupling part comprising at least a first coupling element and at least a second element of coupling that can be hooked with the intervertebral implant in the coupling position.

The surgical instruments of the class initially described are used in spine surgery vertebral as review tools, well to proceed to the correction of an intervertebral implant position or to lead to carry out a review, that is to withdraw it completely out of the intervertebral space. An example of a surgical instrument of this class is described in US 2004/0059318 A1. The coupling piece of the known instrument comprises a stop which it can settle in the intervertebral implant, as well as some elastic hooks protruding distally, so that you can hold the intervertebral implant between the stop and the hooks The drawback of an instrument of this class is that with he can only remove intervertebral implants from a Same model and size.

Therefore it is the objective of the present invention improve a surgical instrument of the described class initially so that it can also be used to remove different intervertebral implants of different sizes and shapes.

This objective is solved in an instrument surgical according to the invention of the class initially described  for the fact that the at least one first element of coupling and the at least a second coupling element are willing to move with each other in such a way that the separation of the at least one first element can be varied coupling and the at least a second element of coupling in a direction parallel to a longitudinal axis defined by the instrument, to pass the instrument of the seat position to the coupling position and / or vice versa.

The proposed improvement according to the invention for known review instruments has the advantage that with the instrument you can remove implants intervertebral of different size and shape of a space intervertebral Therefore, for different implants intervertebral only a single instrument is needed that It can be applied to any intervertebral implant and to Then it can be brought to the coupling position. This is possible thanks to the variation of the separation between the least a first coupling element and the at least one Second coupling element. For example the at least one first coupling element and the at least one second coupling element can penetrate the position of hollow coupling of the intervertebral implant, thus remaining hooked with it, or just sit on seating surfaces the same provided for that purpose, which also represents a form hooking. So that the instrument can be held with safety by an operator during surgery is advantageously provided at a proximal end of the instrument a handle piece to hold it. To improve the stability of the union of the instrument with an intervertebral implant is it is advisable that two first elements of coupling

It is also advantageous if two are planned. Second coupling elements.

To enable individual adaptation of the instrument to intervertebral implants of various forms, by example also the seat and attachment of the instrument to an implant intervertebral in a direction or plane that cannot be assigned to a plane of symmetry of the intervertebral implant, it is convenient that the two second coupling elements can move independently of each other. This way it can be adjusted by example a different distance between a first and a second coupling element and another first and a second element of coupling

According to a preferred embodiment of the invention it can be provided that the at least one first coupling element and the at least one second coupling element are arranged and supported on the instrument such that they can be moved with a relative movement between them, parallel or essentially parallel to the longitudinal axis. In this way the structure of the instrument is greatly simplified, and in addition an instrument of this kind allows for example to pass the second coupling elements along a
articulation part of an intervertebral implant that is movably held between two seat plates of the latter.

It is advantageous that the instrument comprises a stem that defines the longitudinal axis, and that the part of coupling is arranged at the distal end or in the area of the distal end of the stem. An instrument that presents a stem of this class can also be used for example for a minimal invasive intervention, to correct a position of the intervertebral implant in the intervertebral space or for the revision.

So that an operator can check especially the orientation of the at least one first and / or the at least a second coupling element easily and to facilitate the seat of the instrument against an implant intervertebral, it is advantageous that the at least one first element coupling is located at the distal end or in the area of the distal end of the stem.

The instrument can be supported in a way especially simple against an intervertebral implant and hook it with this one and the at least a first element of coupling is made in the form of a coupling boss distal or directed essentially in the distal direction. A projection of coupling of this class can penetrate the position of coupling in a corresponding recess, in particular in a Blind hole of the intervertebral implant.

The instrument is preferably provided at least one axial stop to limit the movement of intervertebral implant approach and instrument. This ensures that the instrument can be support the intervertebral implant in a defined way, and that in the case of a correction of the implant position or a review, this can be safely supported again and defined.

An arrangement is essentially obtained simple of the instrument if at least one axial stop comprises a stop surface oriented distally or essentially distal, against which the intervertebral implant can settle for at least part of its surface in the coupling position. The stop surface may in particular also be a part of an implant housing provided in the instrument that is performed corresponding to the intervertebral implant, and in the which intervertebral implant can be introduced for example with A geometric fit.

You get a force transmission and support especially good instrument and intervertebral implant each other if the at least one axial stop is located adjacent to or in the area of the at least one coupling element.

The stability of the instrument is increased and intervertebral implant removal is facilitated if at each First coupling element corresponds to an axial stop.

According to an embodiment preferred of the invention may be provided that the at least a second coupling element comprises a surface of tighten in the direction towards at least one axial stop, so that in the coupling position the implant intervertebral can be fastened with geometric adjustment and / or press between the pressure surface and the at least one first axial stop. Thanks to this configuration it can be fastened with safety an intervertebral implant of different shape and size with a geometric and / or force adjustment between the at least a first and the at least a second coupling element.

In order to simplify both the design and the manufacture of the instrument is convenient that the instrument present a plane of symmetry that includes the longitudinal axis. Is advantageous that the at least a second coupling element can be moved distally in the seating position of such so that the separation between the at least a first and the at less a second coupling element is greater than in the coupling position in which the intervertebral implant is can be fastened with geometric and / or force adjustment between the at least a first and the at least a second element of coupling This improvement according to the invention allows the instrument to be brought closer to the intervertebral implant of such so that it can comfortably penetrate between the at least one first and the at least a second coupling element. Only to hold firmly with geometric and / or force adjustment the intervertebral implant in the instrument, separation is reduced between the at least one first and the at least one second coupling element, so that it adopts the position of coupling

It is convenient that the at least one second coupling element can move both in direction proximal in the seating position that in relation to the axis longitudinal take a position on the proximal side of the minus a first coupling element. In this way it is possible first approach only the at least one first element of coupling to the intervertebral implant without hindering the at least a second coupling element. In the position of described seat therefore adopts what is called a position withdrawal.

The instrument can be passed especially simple from the seat position to the position of  coupling and / or vice versa, if at least a second element of coupling is movable in a plane transverse to the axis longitudinal to move the instrument from the seating position to The coupling position.

In principle you could imagine that the at least a second coupling element is arranged in a support with elastic support. However it can be carried so especially simple and defined from the seating position to the coupling position if the at least a second element of coupling has rotating support around a longitudinal axis of the coupling element that runs parallel or essentially parallel to the longitudinal axis. In this way, and to difference of the instrument described in US 2004/0059428 A1, the instrument can be carried by controlled torsion of at least a second element around the longitudinal axis of the coupling element from the seating position to the coupling position and vice versa, so that the instrument it can also be easily removed from the implant again intervertebral

The separation between the at least one first and the at least a second coupling element can be vary especially easily if the instrument is provided at least one thrust and traction element supported by movable shape, in parallel or essentially parallel direction to longitudinal axis, and if the at least a second element of coupling is arranged at a distal end or in the area of this in the thrust and pull element, protruding transversely with respect to it or at least transversely with respect to the longitudinal axis. With the push and pull element you can easily push forward at least a second coupling element distally and can be also withdraw proximally, which can be vary the separation between the at least one first and the at minus a second coupling element.

So that the at least one second element coupling can be easily moved in one plane transverse to the longitudinal axis, it is convenient that the at least a pushing and pulling element defines a longitudinal axis of the coupling element and rest on the rotating instrument around that one.

According to an embodiment preferred of the invention may be provided that in the instrument  a rotating support is provided for the thrust element and traction to drive a displacement and / or a rotation of the element of thrust and traction in a direction parallel to the longitudinal axis of the coupling element. The planned rotating support allows make a simple relative movement of the at least one first and of the at least a second coupling element the one relative to each other, both in a direction parallel to the axis longitudinal as well as in a transverse plane to it.

The pushing and pulling element can be easily moved by an operator if at a proximal end a handle is provided therein.

It may be convenient for the at least one thrust and pull element present at its proximal end or in the zone of this one at least one marker element that indicates in which direction indicates the at least a second element of coupling In this way the operator can recognize immediately if the instrument adopts the seating position or the coupling position, since this can be defined for example by a certain turning position of at least one second coupling element relative to the longitudinal axis of the coupling element.

The structure of the instrument results especially simple if the at least one marker element is a projection protruding transversely from the axis longitudinal of the coupling element, located oriented in the same address as the at least one second element of coupling In this way, an operator can recognize directly in which direction the at least one second points coupling element, although a distal end thereof penetrate into a human or animal body and is not visible.

To prevent an intervertebral implant subject with geometric adjustment and / or force on the instrument in the coupling position can be released from it, it is convenient that a movable support stop is provided on the instrument for limit movement distally for at least one second coupling element. This prevents separation between the at least a first coupling element and the by at least a second coupling element can increase so involuntary

It is especially convenient if the top of movable support is located in the thrust element and of traction. This way you can directly limit the movement of the pushing and pulling element by varying the position of the stop, top, maximum as a noun, top as an adverb.

To simplify the structure of the instrument it may be convenient for the thrust and pull element comprise a threaded section and that the movable support stop understand a nut that corresponds to the threaded section and go curled over it. This nut can be used for example also as a locknut to ensure a position of coupling in which the intervertebral implant is attached, by tight example between the at least one first and the at least A second coupling element.

The movable support stop is arranged conveniently on the stem. The movable support stop can be connected for example with the swivel support or supported on the stem so that it can act together with a projection in the pushing and pulling element, for example a rotary knob arranged in the pushing and pulling element. In this way it can be built especially easily in particular  the thrust and traction element.

It can also be advantageous if at one end proximal instrument is arranged an end plate oriented  transversely or essentially transversely with respect to the axis longitudinal. This may be located in particular distanced from an instrument handle, for example in an extension of the instrument stem beyond the handle. The plate terminal especially facilitates implant removal intervertebral intervertebral space, as it can serve as stop for an eject tool, for example a hammer grooved

The objective initially set is resolved also according to the invention by an implantation system that comprises an intervertebral implant to be placed in a space intervertebral between two adjacent vertebrae of a spine human or animal vertebral, and a surgical instrument to remove the intervertebral implant outside the intervertebral space, the intervertebral implant comprising two seating elements to seat against the adjacent vertebrae, which are joined between yes in a rigid or articulated way, due to the fact that at least one of the two seating elements comprises at least a first coupling element and at least a second element of coupling, because the surgical instrument is one of the surgical instruments described above and because the at least one first coupling element can be brought into engagement with the at least a first coupling element and because in the coupling position the at least a second element of coupling can be carried to couple with the at least one Second coupling element.

The implant coupling elements intervertebral can be formed for example by gaps, in particular blind holes or recesses or recesses at one end anterior or posterior intervertebral implant, or in parts of this one, for example in the seat elements. In particular, the intervertebral implant and instrument may be adjusted each other in such a way that the intervertebral implant can be held  firmly in the instrument. The instrument can be used also to remove different intervertebral implants, in particularly also for implants that are not ready Especially for the instrument.

The objective initially set is resolved also by a procedure to remove an implant intervertebral of an intervertebral space between two vertebrae contiguous of a human or animal spine, for which it first hook at least a first element of coupling of a surgical instrument with at least one part of the intervertebral implant in a seating position, then moving at least a second element of distal direction coupling along the at least one part of the intervertebral implant, the tightening being less a part of the intervertebral implant between the at least a first coupling element and the at least one second coupling element in the coupling position thanks to a movement of the first and second coupling element the one relative to the other, retreating out of the intervertebral space the at least part of the intervertebral implant attached with tighten on the instrument in the coupling position, using the movement of the instrument in the proximal direction.

This procedure is passed very controlled the instrument from the seat position to the position  of coupling by a movement of the at least one first and of the at least a second coupling element, the one Regarding the other.

Advantageously it is used for the procedure One of the instruments described above.

It is also advantageous if the procedure is employs an implantation system as described previously.

The following description of a form of preferred embodiment of the invention serves as further clarification Detailed, in combination with the drawing. In this one they show:

Figure 1: a perspective view of a implantation system according to the invention before setting the instrument in an intervertebral implant;

Figure 2: An enlarged perspective view of the implantation system of Figure 1, seen obliquely from above;

Figure 3: Another perspective view of the system of implantation according to the invention, in an oblique view from in front of.

Figure 1 shows a system of implementation according to the invention designated as a whole by reference 10. Includes an intervertebral implant 12 and a surgical instrument to remove the intervertebral implant 12 of intervertebral space 14 between adjacent vertebrae 16 and 18 of a spine 20, in the form of a review instrument designated as a whole by reference 22. The implant intervertebral 12 is performed in the form of a disc prosthesis intervertebral with two seat elements 24 and 26 in the form of plate that seat respectively in a vertebra 16 and 18, as well as by a false element 28 that rests on the seating element 24 with a spherical joint surface that is not represented, on which a corresponding surface sits of the seating element 26, so that the two elements of seat 24 and 26 can be moved together essentially forming a kneecap joint.

The intervertebral implant 12 is placed normally in the intervertebral space 14 so that in the seating elements 24 and 26 there are coupling elements provided respectively in pairs in the form of blind holes 30 and 32, aligned parallel to each other with their longitudinal axes and oriented in ventral direction. Each of the elements of seat 24 and 26 has another pair of coupling elements that they are made in a dorsal face, that is to say a back face of the respective seating element 24 or 26 in the form of recesses 34 and 36 respectively. Each recess 34 in the seat element 24 is located in front of a recess 36 in the seat element 26, being openings 34 both dorsally and also in direction towards the respective seating element 26, and the recesses 36 both in the dorsal direction and in the direction of the respective seating element 24.

Review instrument 22 presents a rod 40 in the form of a solid bar that defines a longitudinal axis 38, which at its distal end has a coupling piece 42 and at a proximal end a handle 44 to hold the revision instrument 22. At the distal end of the stem 40 is an end plate 46 arranged precisely so that a perpendicular to the surface of the end plate 46 elapses perpendicular to the longitudinal axis 38. The end plate 46 is arranged on the rod 40 somewhat displaced below the axis longitudinal 38 and has a flat U-shaped recess 48, which is open oriented distally and forms a housing of the implant. Next to the recess 48 there are two front surfaces 50 oriented distally, like two projections of spike-shaped coupling 52 protruding from the front surfaces 50 and form the first elements of coupling, whose longitudinal axes run parallel to the longitudinal axis 38. Coupling projections 52 are arranged in such a way that they can penetrate either the holes blind 30 or 32 in the seating elements 24 or 26, until the respective seat element 24 or 26 butt against the front surfaces 50, which thus form stops axial that prevent the movement of approaching each other from intervertebral implant 12 and revision instrument 22.

On the terminal board are arranged symmetrically with respect to longitudinal axis 38 and diametrically opposite with reference to rod 40, two bearing bushings elongated 54, which are respectively provided with a groove longitudinal 56 oriented away from the plate terminal 46 and parallel to longitudinal axis 38.

The bearing bushes 54 form together with a bar support 58 a rotating support for two elements of thrust and pull 60. The coupling part 42 comprises the plate terminal 46 which has bearing bushes 54 arranged, the bar supports 58 as well as pushing and pulling elements 60 supported by the rotating support formed in this way. Support from bars 58 comprises two solid support stands 62 that protrude laterally from rod 40, provided with holes housing 64 running parallel to the longitudinal axis 38. They are coaxially aligned with the longitudinal grooves 56, of so that a rod 66 of the pushing and pulling element 60, whose diameter is noticeably smaller than that of the stem 40, can be insert through the housing holes 64 from of the proximal side to introduce them in the respective slot longitudinal 56. Alternatively, one could also imagine the possibility of introducing the rod 66 of the pushing element and traction 60 from the distal side through the bushings of bearing 54 and housing holes 64, joining then a proximal end of the stem 66 with a body of stop, for example by threading or welding. In the area between the bar support 58 and end plate 46, the section of the stems 66 is reduced forming a step in the direction towards its distal end A retention projection 70 is provided therein. which forms a second coupling element, which protrudes laterally of the stem 66 in a transverse direction to an axis length of the coupling element 68 of the rod 66.

At a proximal end of the stem 66 is arranged a rotary knob 72 that also serves as an element of stop, from which a thin spike protrudes radially cylindrical 74 which constitutes a marking element that indicates in the same address as the corresponding retention boss 70 of the pushing and pulling element 60.

In an area of the stem 66 between the support of bars 58 and the rotary knob 72 a threaded section is provided 76, on which an elongated lock nut 78 is screwed into the direction of the longitudinal axis of the coupling element 68, which forms a stop to limit the relative movement of the element of thrust and traction 60 and bar support 58, due to the fact that the locknut stops with its distal end 80 against the support of bars 58.

As an alternative to the review instrument 22 described above it is also possible to imagine instruments that in principle have a single thrust and traction element 60, and therefore also only a second coupling element. But alternatively one could also imagine three or more elements of corresponding thrust and traction 60. Similarly they can be also provided for in the review instrument only one or also more than three coupling projections 52 forming the First coupling elements.

Revision instrument 22 is manufactured preferably entirely of metal and sterilizable, except for handle 44.

It should also be noted that the instrument of revision 22 is performed as a whole with symmetry with respect to a plane of symmetry containing the longitudinal axis 38.

The following describes in greater detail the operation of review instrument 22 and a procedure to remove the intervertebral implant 12 from the space intervertebral 14.

Before applying the end plate 46 to one of the seating elements 24 or 26 are preferably removed both pushing and pulling elements 60 until the projections of retaining 70 butt with a clamping surface 82 in the bearing bushing 54, oriented proximally. The retention projections 70 therefore occupy, in a position of seat relative to longitudinal axis 38, a side position proximal of the coupling projections 52. Now the projections of coupling 52 can be easily inserted into the blind holes 30 or 32. In this seating position you can advance the thrust and traction elements 60 in direction distal, such that the distal ends of the stems 66 are move with retention projections 70 between the elements of seat 24 and 26 and laterally next to the insert 28, until that the retention projections 70 protrude from a rear face of the seating elements 24 and 26. Then the pushing and pulling elements 60 an angle of 90 ° and are removed until retention projections 70 penetrate recesses 34 or 36 respectively. Alternatively, one could also imagine advance the thrust and traction elements 60 only what enough for retention protrusions 70 to adopt in the area of recesses 34 and 36 a position in which by turning of 90º of the pushing and pulling element 60 the projections of retention 70 can be turned inside recesses 34 or 36 respectively. The clamping surfaces 82 meet then in both cases on a seating surface oriented in distal direction with respect to the corresponding recess 34 or 36. The review instrument 22 then adopts the position of coupling shown in Figure 3.

To ensure revision instrument 22 in one of the seating elements 24 or 26, the locknuts 78 in the direction of rod support 58, so that the corresponding seating element 24 or 26 is subject to pressure between the front surfaces 50 and the surfaces of tighten 82.

Removing the review instrument 22 in one of the seat elements 24 can be removed proximally or 26 of the intervertebral space. In an analogous way it can be removed also the other seating element that remains in space intervertebral 14.

In order to also be able to remove from space intervertebral 14 intervertebral implants 12 that seat very firmly, can be optionally and distanced from the handle 14 and closer to it in an extension of the stem 40, a terminal plate not shown, oriented transversely to to the longitudinal axis 38, so that it can be struck against this end plate using an eject tool, for example a hammer or a slotted hammer, thus expelling the intervertebral implant 12 outside the intervertebral space 14.

With revision instrument 32 in accordance with the invention not only can a class of implants be removed intervertebral 12 such as those depicted in Figures 1 to 3 but also intervertebral implants not represented by different size. And this because the separation between the projection of coupling 52 and retention boss 70 is variable thanks to the relative mobility between the coupling boss 52 and the retention projection 70, for example by displacing the element of thrust and traction distally or proximally, parallel to the axis longitudinal of the coupling element 68.

Claims (31)

1. Surgical instrument (22) for removing an intervertebral implant (12) from an intervertebral space (14) of a human or animal spine 20, comprising a coupling piece (42) arranged at the distal end of the instrument (22) for sit against the intervertebral implant (12) in a seating position, the coupling piece (42) being able to be brought from the seating position to a coupling position in which the intervertebral implant (12) is attached to the coupling piece ( 42) with a geometric and / or force adjustment, the coupling part (42) comprising at least a first coupling element (52) and at least a second coupling element (70) which in the coupling position is it can become engaged with the intervertebral implant (12), characterized in that the at least one first coupling element (52) and the at least one second coupling element (70) are arranged with the possibility of m oversees with respect to each other such that the separation of the at least one first coupling element (52) and the at least one second coupling element (70) can be varied in a direction parallel to a longitudinal axis (38 ) defined by the instrument (22), to pass the instrument (22) from the seating position to the coupling position and / or vice versa. 2. Surgical instrument according to claim 1, characterized in that at a proximal end of the instrument (22) a handle (44) is provided for holding the instrument (22). 3. Surgical instrument according to one of the preceding claims, characterized in that two first coupling elements (52) are provided. 4. Surgical instrument according to one of the preceding claims, characterized in that two second coupling elements (70) are provided. 5. Surgical instrument according to claim 4, characterized in that the two second coupling elements (70) can move independently of each other. 6. Surgical instrument according to one of the preceding claims, characterized in that the at least one first coupling element (52) and the at least one second coupling element (70) are arranged and supported in this way on the instrument (22 ) that can be moved relative to each other in a parallel direction or essentially parallel to the longitudinal axis (38). A surgical instrument according to one of the preceding claims, characterized in that the instrument (22) comprises a rod (40) defining the longitudinal axis (38) and that the coupling part (42) is arranged at the distal end or in the zone of the distal end of the stem. A surgical instrument according to claim 7, characterized in that the at least one first coupling element (52) is disposed at the distal end or in the area of the distal end of the rod (40). 9. Surgical instrument according to one of the preceding claims, characterized in that the at least one first coupling element (52) is made in the form of a coupling projection (52) oriented distally or essentially distally. 10. Surgical instrument according to one of the preceding claims, characterized in that in the instrument (22) at least one axial stop (50) is provided to limit an approaching movement between the intervertebral implant (12) and the instrument (22) . 11. Surgical instrument according to claim 10, characterized in that the at least one axial stop (50) comprises a stop surface (50) oriented distally or essentially distally, in which the intervertebral implant can settle on the surface ( 12) at least in part, in the coupling position. 12. Surgical instrument according to one of claims 10 or 11, characterized in that the at least one axial stop (50) is arranged adjacent or in the area of the at least one first coupling element (52). 13. Surgical instrument according to one of claims 10 to 12, characterized in that each of the first coupling elements (52) corresponds to an axial stop (50). 14. Surgical instrument according to one of claims 10 to 13, characterized in that the at least a second coupling element (70) comprises a clamping surface (82) oriented towards the at least one axial stop (50), so that the intervertebral implant (52) can be held with geometric adjustment and / or tightening in the coupling position between the tightening surface (82) and the at least one axial stop
(fifty). 15. Surgical instrument according to one of the preceding claims, characterized in that the instrument (22) has a plane of symmetry comprising the longitudinal axis (38). 16. Surgical instrument according to one of the preceding claims, characterized in that the at least one second coupling element (70) can be moved in the seat position distally so that a separation between the at least one first and the at least one second coupling element (52, 70) is greater than in a coupling position in which the intervertebral implant (12) can be held with a geometric and / or force adjustment between the at least a first and the at least a second coupling element (52, 70). 17. Surgical instrument according to one of the preceding claims, characterized in that the at least one second coupling element (70) can be moved in the seating position both proximally and in relation to the longitudinal axis l (38) adopts a position on the proximal side of the at least one first coupling element (52). 18. Surgical instrument according to one of the preceding claims, characterized in that the at least one second coupling element (70) can be moved in a plane transverse to the longitudinal axis (38) to pass the instrument (22) from the seating position to the coupling position. 19. Surgical instrument according to one of the preceding claims, characterized in that the at least one second coupling element (70) rotatably supports about a longitudinal axis (68) of the coupling element, which runs parallel or essentially parallel to the longitudinal axis ( 38). 20. Surgical instrument according to one of the preceding claims, characterized in that the instrument (22 is provided with at least one thrust and traction element (60) supported movable in a direction parallel to or essentially parallel to the longitudinal axis (38) and because the at least a second coupling element (70) is disposed at a distal end or in the area thereof in the thrust and traction element (60) and protrudes from it transversely or essentially in the direction transverse to the longitudinal axis (38). 21. Surgical instrument according to claim 20, characterized in that the at least one thrust and pull element (60) defines a longitudinal axis of the coupling element (68) and is supported on the rotating instrument (22) around it. 22. Surgical instrument according to claim 21, characterized in that a rotating support (54, 58) for the thrust and traction element (60) is provided in the instrument (22) to guide a movement and / or a twist of the thrust element and traction (60) in a direction parallel to the longitudinal axis of the coupling element (68). 23. Surgical instrument according to one of claims 20 to 22, characterized in that a handle (72) is provided at a proximal end of the second pushing and pulling element (60). 24. Surgical instrument according to one of claims 20 to 23, characterized in that the at least one thrust and traction element (60) has at least one marker element (74) at its proximal end or in the area thereof in which direction the at least one second coupling element (70) points. 25. Surgical instrument according to claim 24, characterized in that the at least one marker element (74) is a projection (74) projecting in a direction transverse to the longitudinal axis of the coupling element (68), which is positioned oriented therein. direction than the at least a second coupling element (70). 26. Surgical instrument according to one of claims 20 to 25, characterized in that a movable support stop (78) is provided in the instrument to limit distally a movement of at least a second coupling element (70). 27. Surgical instrument according to claim 26, characterized in that the movable support stop (78) is located in the pushing and pulling element (60). 28. Surgical instrument according to claim 27, characterized in that the thrust and traction element (60) comprises a threaded section (76) and that the movable support stop (78) comprises a nut (78) corresponding to the threaded section (76) and that is threaded on it. 29. Surgical instrument according to claim 26, characterized in that the movable support stop (78) is located in the rod (40). 30. Surgical instrument according to one of the preceding claims, characterized in that, at a proximal end of the instrument (22), an end plate oriented in transverse or essentially transverse direction with respect to the longitudinal axis (38) is arranged. 31. Implant system (10) comprising an intervertebral implant (12) to insert in an intervertebral space (14) between two adjacent vertebrae (16, 18) of a human or animal spine (20), and a surgical instrument (22 ) to remove the intervertebral implant (12) outside the intervertebral space (14), the intervertebral implant (12) comprising two seating elements (24, 26) to seat in the adjacent vertebrae (16, 18), which are joined together rigid or articulated, characterized in that at least one of the two seating elements (24, 26) has at least a first coupling element (30, 32) and at least a second coupling element (34, 36 ), because the surgical instrument (22) is an instrument (22) according to one of the preceding claims and because the at least one first coupling element (30, 32) can be coupled with at least a second element coupling (52) and because in the coupling position, the at least a second coupling element (34, 36) can be coupled with the at least a second coupling element (70).